Aimovig (erenumab-aooe)

Drugs

What is Aimovig?

Aimovig is a brand-name prescription medication that’s used to prevent migraine headaches in adults. It comes in a prefilled autoinjector pen. You use the autoinjector to give yourself an injection at home once per month. Aimovig can be prescribed in one of two doses: 70 mg per month or 140 mg per month.

Aimovig contains the drug erenumab. Erenumab is a monoclonal antibody, which is a type of drug developed in a lab. Monoclonal antibodies are drugs made from immune system cells. They work by blocking the activity of certain proteins in your body.

Aimovig can be used to prevent both episodic migraine and chronic migraine headaches. The American Headache Society recommends Aimovig for people who:

  • can’t reduce their number of monthly migraine headaches enough with other drugs
  • can’t take other migraine medications because of side effects or drug interactions

Aimovig has been shown to be effective in clinical studies. For people with episodic migraine, between 40 percent and 50 percent of those who took Aimovig for six months cut their number of migraine days by at least half. And for people with chronic migraine, about 40 percent of those who took Aimovig cut their number of migraine days by half or more.

A new kind of drug

Aimovig is part of a new class of medications called calcitonin gene-related peptide (CGRP) antagonists. This type of drug was developed for the prevention of migraine headaches.

Aimovig received Food and Drug Administration (FDA) approval in May 2018. It was the first medication to be approved in the CGRP antagonist class of drugs.

Two other drugs in this class of medications were approved after Aimovig: Emgality (galcanezumab) and Ajovy (fremanezumab). A fourth medication, called eptinezumab, is currently being studied in clinical trials.

Aimovig generic

Aimovig is not available in a generic form. It only comes as a brand-name medication.

Aimovig contains the drug erenumab, which is also called erenumab-aooe. The ending “-aooe” is sometimes added to show that the medication is different from similar medications that could be created in the future. Other monoclonal antibody drugs also have name formats like this.

Aimovig side effects

Aimovig can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Aimovig. This list does not include all possible side effects.

For more information on the possible side effects of Aimovig, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects of Aimovig can include:

  • injection site reactions (redness, itchy skin, pain)
  • constipation
  • muscle cramps
  • muscle spasms

Most of these side effects may go away after a few days or a couple of weeks. Call your doctor or pharmacist if you have more severe side effects or effects that don’t go away.

Serious side effects

Serious side effects from Aimovig can occur, but they aren’t common. The main serious side effect of Aimovig is a severe allergic reaction. See below for details.

Allergic reaction

Some people have an allergic reaction after taking Aimovig. This kind of reaction is possible with most medications. Symptoms of a mild allergic reaction might include:

  • having a rash on your skin
  • feeling itchy
  • being flushed (having warmth and redness in your skin)

Rarely, more severe allergic reactions can occur. Symptoms of a severe allergic reaction might include:

  • having swelling under your skin (typically in your eyelids, lips, hands, or feet)
  • feeling short of breath or having trouble breathing
  • having swelling in your tongue, mouth, or throat

Call your doctor right away if you think you are having a severe allergic reaction to Aimovig. Call 911 if your symptoms feel life-threatening or if you’re having a medical emergency.

Weight loss/weight gain

Weight loss and weight gain were not reported in clinical studies of Aimovig. However, some people may see changes in their weight during Aimovig treatment. This may be due to migraine itself rather than to Aimovig.

Some people may not feel hungry before, during, or after a migraine headache. If this occurs often enough, it can lead to unwanted weight loss. If you lose your appetite when you have a migraine headache, work with your doctor to develop a diet plan that makes sure you get all of the nutrients you need.

On the other end of the spectrum, weight gain or obesity are common in people with migraine. And clinical studies have shown that obesity may be a risk factor for worsened migraine headaches or more frequent migraine headaches.

If you’re concerned about how your weight is affecting your migraine headaches, talk with your doctor about ways to manage your weight.

Long-term effects

Aimovig is a recently approved medication in a new class of drugs. As a result, there is very little long-term research available on Aimovig’s safety, and little is known about its long-term effects.

In one long-term safety study that lasted around three years, the most common side effects reported with Aimovig were:

  • back pain
  • upper respiratory infections (such as the common cold or a sinus infection)
  • flu-like symptoms

If you have these side effects and they’re serious or don’t go away, talk with your doctor.

Constipation

Constipation occurred in up to 3 percent of people who took Aimovig in clinical studies.

This side effect may be due to how Aimovig affects calcitonin gene-related peptide (CGRP) in your body. CGRP is a protein that can be found in the intestines and plays a role in the normal movement of the bowels. Aimovig blocks activity of CGRP, and this action can prevent normal bowel movements from happening.

If you experience constipation during treatment with Aimovig, talk with your doctor or pharmacist about remedies that may help relieve it.

Hair loss

Hair loss is not a side effect that’s been linked with Aimovig. If you find that you’re losing hair, talk with your doctor about potential causes and treatments.

Nausea

Nausea is not a side effect that’s been reported with Aimovig use. However, many people with migraine may feel nauseous during a migraine headache.

If you feel nauseous during migraine headaches, it may help to stay in a dark, quiet room, or to go outside for fresh air. You can also ask your doctor or pharmacist about medications that can help prevent or treat nausea.

Fatigue

Fatigue (lack of energy) is not a side effect that’s been linked with Aimovig. But feeling tired is a common symptom of migraine that many people feel before, during, or after a migraine headache occurs.

One clinical study showed that people with migraine who have more intense headaches were more likely to feel fatigue.

If you’re bothered by fatigue, talk with your doctor about ways to improve your energy levels.

Diarrhea

Diarrhea is not a side effect that’s been reported with use of Aimovig. However, it is a rare symptom of migraine. There may even be a link between migraine and inflammatory bowel disease and other gastrointestinal disorders.

If you have diarrhea that lasts longer than a few days, talk with your doctor.

Insomnia

Insomnia (trouble sleeping) is not a side effect that’s been found in clinical studies of Aimovig. However, one clinical study found that people with migraine who have insomnia tend to have more frequent migraine headaches. In fact, lack of sleep may be a trigger for migraine headaches and increase the risk of developing chronic migraine.

If you have insomnia and think it might be affecting your migraine headaches, talk with your doctor about ways to get better sleep.

Muscle pain

In clinical studies, people who received Aimovig did not experience general muscle pain. Some did have muscle cramps and spasms, and in a long-term safety study, people taking Aimovig experienced back pain.

If you have muscle pain while taking Aimovig, it may be due to other causes. For instance, muscle pain in the neck can be a symptom of migraine for some people. Also, injection site reactions, including pain in the area around the injection, may feel like muscle pain. This type of pain should go away within a few days of the injection.

If you have muscle pain that doesn’t go away or is affecting your quality of life, talk with your doctor about pain relief options.

Itching

General itchiness is not a side effect that was seen in clinical studies of Aimovig. However, itchy skin in the area where Aimovig is injected is commonly reported.

Itchy skin near the injection site should go away within a few days. If you have itchiness that doesn’t go away, or if the itchiness is severe, talk with your doctor.


Aimovig cost

As with all medications, prices for Aimovig can vary. To find current prices for Aimovig in your area, check out GoodRx.com.

The cost you find on GoodRx.com is what you would pay without insurance. Your actual cost will depend on your insurance coverage, your location, and the pharmacy you use.

Financial assistance

If you need financial support to pay for Aimovig, help is available.

Amgen and Novartis, the manufacturers of Aimovig, offer an Aimovig Ally Access Card program that can help you pay less for each prescription refill. For more information and to find out if you’re eligible, call 833-246-6844 or visit the program website.


Aimovig uses

The Food and Drug Administration (FDA) approves prescription drugs such as Aimovig to treat or prevent certain conditions.

Aimovig for migraine headaches

Aimovig is FDA-approved for the prevention of migraine headaches in adults. These severe headaches are the most common symptom of migraine, which is a neurological condition.

Other symptoms can occur with a migraine headache, such as:

  • nausea
  • vomiting
  • sensitivity to light and sound
  • trouble speaking

Migraine can be classified as either episodic or chronic, according to the International Headache Society. Aimovig is approved to prevent both episodic migraine and chronic migraine headaches. The differences between these types of migraine are:

  • episodic migraine causes fewer than 15 headache or migraine days per month
  • chronic migraine causes 15 or more headache days per month over a period of at least three months, with at least eight of the days being migraine days

Uses that are not approved

Aimovig may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is prescribed to treat a different condition.

Aimovig for cluster headaches

Aimovig is not FDA-approved to prevent cluster headaches, but it may be used off-label for this purpose. It’s not currently known if Aimovig is effective at preventing cluster headaches.

Cluster headaches are painful headaches that occur in clusters (many headaches over a short period of time). They can be either episodic or chronic. Episodic cluster headaches have longer periods of time between clusters of headaches. Chronic cluster headaches have shorter periods between headache clusters.

Aimovig has not been tested for prevention of cluster headaches in clinical studies. However, other drugs that belong to the same class of medications as Aimovig, including Emgality and Ajovy, have been tested.

In one clinical study, Emgality was found to help prevent episodic cluster headaches. But for a clinical trial of Ajovy, the drug manufacturer stopped the study early because Ajovy wasn’t working to reduce the number of chronic cluster headaches for people in the study.

Aimovig for vestibular headaches

Aimovig is not FDA-approved to prevent or treat vestibular headaches. Vestibular headaches are different from classic migraine headaches because they’re usually not painful. People with vestibular headaches may feel dizzy or experience vertigo. These symptoms may last seconds to hours.

Clinical studies have not been done to show if Aimovig is effective at preventing or treating vestibular headaches. But some doctors may still choose to prescribe the drug off-label for this condition.

Aimovig dosage

The Aimovig dosage your doctor prescribes will depend on several factors. These include the severity of the condition you’re using Aimovig to treat.

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Forms and strengths

Aimovig comes in a single-dose, prefilled autoinjector that’s used to give a subcutaneous injection (an injection that goes under the skin). The autoinjector comes in one strength: 70 mg per injection. Each autoinjector is meant to be used once only and then discarded.

Dosage for migraine

Aimovig can be prescribed in two doses: 70 mg or 140 mg. Either dose is taken once per month.

If your doctor prescribes 70 mg, you’ll give yourself one injection per month (using one autoinjector). If your doctor prescribes 140 mg, you’ll give yourself two injections per month, one right after the other (using two autoinjectors).

Your doctor will start your treatment at 70 mg per month. If this dosage does not decrease your number of migraine days enough, your doctor may increase your dosage to 140 mg per month.

What if I miss a dose?

Take a dose as soon as you realize that you missed one. Your next dose should be one month after that one. Remember the new date so you can plan for your future doses.

Will I need to use this drug long term?

If Aimovig is effective at preventing migraine headaches for you, you and your doctor may decide to continue treatment with Aimovig long term.

Alternatives to Aimovig

Other drugs are available to help prevent migraine headaches. Some may work better for you than others. If you’re interested in trying a treatment other than Aimovig, talk with your doctor to learn more about other drugs that may work well for you.

Examples of other medications that are FDA-approved for preventing migraine headaches include:

  • other calcitonin gene-related peptide (CGRP) antagonists:
    • fremanezumab-vrfm (Ajovy)
    • galcanezumab-gnlm (Emgality)
  • certain seizure medications, such as:
    • divalproex sodium (Depakote)
    • topiramate (Topamax, Trokendi XR)
  • the neurotoxin onabotulinumtoxinA (Botox)
  • the beta-blocker propranolol (Inderal, Inderal LA)

Some drugs are used off-label to prevent migraine headaches. These medications include:

  • some antidepressants, such as amitriptyline or venlafaxine (Effexor XR)
  • some seizure medications, such as valproate sodium
  • some beta-blockers, such as metoprolol (Lopressor, Toprol XL) or atenolol (Tenormin)

CGRP antagonists

Aimovig is part of a new class of drugs called calcitonin gene-related peptide (CGRP) antagonists. Aimovig was approved by the FDA in 2018 to prevent migraine headaches. Two other CGRP antagonists called Ajovy and Emgality were also recently approved. A fourth drug in this class (eptinezumab) is expected to be approved soon.

How they work

The approved CGRP antagonists work in similar ways to prevent migraine headaches.

CGRP is a protein in your body that’s been linked with inflammation and vasodilation (widening of blood vessels) in the brain. This inflammation and vasodilation can result in pain from migraine headaches. To cause these effects, CGRP needs to bind (attach) to its receptors, which are sites on the surface of some of your brain cells.

Ajovy and Emgality both work by binding to CGRP itself. As a result, CGRP can’t bind to its receptors. Unlike the other two drugs in this class, Aimovig works by binding to the brain cell receptors. This blocks the CGRP from doing this.

By blocking CGRP from interacting with its receptor, all three drugs help stop inflammation and vasodilation. This can help prevent migraine headaches.

Side by side

The chart below compares basic information about the three FDA-approved drugs in this class that are used to prevent migraine headaches. To learn more about how Aimovig compares with these other drugs, see the following section (“Aimovig vs. other drugs”).

Aimovig Ajovy Emgality
Approval date for migraine prevention May 17, 2018 September 14, 2018 September 27, 2018
Drug ingredient Erenumab-aooe Fremanezumab-vfrm Galcanezumab-gnlm
How it’s administered Subcutaneous self-injection using a prefilled autoinjector Subcutaneous self-injection using a prefilled syringe Subcutaneous self-injection using a prefilled pen or syringe
Dosing Monthly Monthly or every three months Monthly
How it works Prevents CGRP’s effects by blocking the CGRP receptor, which prevents CGRP from binding to it Prevents CGRP’s effects by binding to CGRP, which prevents it from binding to the CGRP receptor Prevents CGRP’s effects by binding to CGRP, which prevents it from binding to the CGRP receptor
Cost* $575/month $575/month or $1,725/quarter $575/month

* Prices can vary depending on your location, the pharmacy used, your insurance coverage, and manufacturer assistance programs.


Aimovig vs. other drugs

You may wonder how Aimovig compares to other medications that are prescribed for similar uses. Below are comparisons between Aimovig and several medications.

Aimovig vs. Ajovy

Aimovig contains the drug erenumab, which is a monoclonal antibody. Ajovy contains the drug fremanezumab, which is also a monoclonal antibody. Monoclonal antibodies are medications created in a lab. These drugs are developed from immune system cells. They work by blocking the activity of certain proteins in your body.

Aimovig and Ajovy both stop the activity of a protein called calcitonin gene-related peptide (CGRP). CGRP causes inflammation and vasodilation (widening of blood vessels) in the brain, which may result in migraine headaches. Blocking CGRP helps prevent migraine headaches.

Uses

Aimovig and Ajovy are both FDA-approved to prevent migraine headaches in adults.

Forms and administration

Aimovig and Ajovy both come in an injectable form that’s administered under your skin (subcutaneous). You can give the injection to yourself at home. Both drugs can be self-injected in certain areas, such as:

  • your belly
  • the front of your thighs
  • the back of your upper arms

Aimovig is supplied as a single-dose prefilled autoinjector. It’s usually given as a 70-mg injection once per month. However, some people are prescribed a higher dose of 140 mg each month.

Ajovy is supplied as a single-dose prefilled syringe. It can be given as a single injection of 225 mg once each month. Or it can be given as three injections of 225 mg once every three months.

Side effects and risks

Aimovig and Ajovy work in similar ways and cause some of the same side effects. The common and serious side effects of both drugs are below.

More common side effects

These lists contain examples of more common side effects that can occur with Aimovig, with Ajovy, or with both drugs (when taken individually).

  • Can occur with Aimovig:
    • constipation
    • muscle cramps or spasms
    • upper respiratory infection (such as the common cold or a sinus infection)
    • flu-like symptoms
    • back pain
  • Can occur with Ajovy:
    • no unique common side effects
  • Can occur with both Aimovig and Ajovy:
    • injection site reactions such as pain, itchiness, or redness

Serious side effects

The primary serious side effect for both Aimovig and Ajovy is a severe allergic reaction. Such a reaction isn’t common, but it is possible. (For more information, see “Allergic reaction” under “Aimovig side effects” above).

Immune reaction

In clinical trials done for both Aimovig and Ajovy, a small number of people had an immune reaction to the drugs. The reaction caused their bodies to develop antibodies against the medications.

Antibodies are proteins made by the immune system to fight off foreign substances in your body. Your body can develop antibodies to any foreign substance, including monoclonal antibodies. If your body makes antibodies to Aimovig or Ajovy, the drug may no longer work for you.

In clinical trials for Aimovig, more than 6 percent of people developed antibodies to the drug. In ongoing clinical studies, fewer than 2 percent of people developed antibodies to Ajovy.

Because Aimovig and Ajovy were approved in 2018, it’s still too early to know how common this effect might be and how it might affect how people use these drugs in the future.

Effectiveness

Aimovig and Ajovy are both effective at preventing migraine headaches, but they haven’t been directly compared in clinical trials.

However, migraine treatment guidelines recommend either drug as an option for certain people. These include people who:

  • can’t reduce their monthly migraine days enough with other medications
  • can’t tolerate other medications because of side effects or drug interactions

Episodic migraine

Separate studies of Aimovig and Ajovy showed effectiveness for preventing episodic migraine headaches.

  • In clinical studies of Aimovig, about 40 percent of people with episodic migraine who received 70 mg of the drug monthly cut their migraine days by at least half over six months. Up to 50 percent of people who received 140 mg had similar results.
  • In a clinical study of Ajovy, around 48 percent of people with episodic migraine who received monthly treatment with the drug cut their migraine days by at least half over three months. About 44 percent of people who received Ajovy every three months had similar results.

Chronic migraine

Separate studies of Aimovig and Ajovy also showed effectiveness for preventing chronic migraine headaches.

  • In a three-month clinical study of Aimovig, about 40 percent of people with chronic migraine who received either 70 mg or 140 mg of the drug monthly had half as many migraine days or fewer.
  • In a three-month clinical study of Ajovy, almost 41 percent of people with chronic migraine who received monthly Ajovy therapy had half as many migraine days after treatment or fewer. Of the people who received Ajovy every three months, around 37 percent had similar results.

Costs

Aimovig and Ajovy are both brand-name medications. There are no generic forms of either drug available. Brand-name medications generally cost more than generic forms.

Based on estimates from GoodRx.com, Aimovig and Ajovy cost roughly the same amount. The actual price you would pay for either drug would depend on your insurance plan, your location, and the pharmacy you use. Your price for Aimovig would also depend on your dose.

Aimovig vs. Botox

Aimovig contains a monoclonal antibody called erenumab. A monoclonal antibody is a type of drug developed in a lab. These drugs are made from immune system cells. Aimovig works to prevent migraine headaches by blocking the activity of a specific protein that can cause them.

Botox contains the drug onabotulinumtoxinA. This drug belongs to a class of medications called neurotoxins. Botox works by temporarily paralyzing the muscles that it’s injected into. This effect prevents pain signals in the muscles from being activated. It’s thought that this process helps prevent migraine headaches before they start.

Uses

Aimovig is approved by the FDA to prevent episodic or chronic migraine headaches in adults.

Botox is FDA-approved to prevent chronic migraine headaches in adults. Botox is also approved to treat several other conditions, such as:

Forms and administration

Aimovig comes as a single-dose prefilled autoinjector. It’s given as an injection under your skin (subcutaneous) that you can give yourself at home. It’s given at a dose of 70 mg or 140 mg per month.

Aimovig can be injected in certain areas of body. These are:

  • your belly
  • the front of your thighs
  • the back of your upper arms

Botox is only given in a doctor’s office. It’s injected with a syringe into a muscle (intramuscular), usually every 12 weeks. The usual sites for injection include:

  • your forehead
  • the back of your neck and shoulders
  • above and near your ears
  • near your hairline at the base of your neck

Your doctor will typically give you 31 small injections in these areas at each appointment.

Side effects and risks

Aimovig and Botox are both used to prevent migraine headaches, but they work in different ways. Therefore, they have some similar side effects and some different.

More common side effects

These lists contain examples of serious side effects that can occur with Aimovig, with Botox, or with both drugs (when taken individually).

  • Can occur with Aimovig:
    • constipation
    • muscle cramps
    • muscles spasms
    • back pain
    • upper respiratory infection (such as the common cold or a sinus infection)
  • Can occur with Botox:
    • headache or worsening migraine
    • eyelid droop
    • facial muscle paralysis
    • neck pain
    • muscle stiffness
    • muscle pain and weakness
  • Can occur with both Aimovig and Botox:
    • injection site reactions
    • flu-like symptoms

Serious side effects

These lists contain examples of serious side effects that can occur with Aimovig, with Botox, or with both drugs (when taken individually).

  • Can occur with Aimovig:
    • few unique serious side effects
  • Can occur with Botox:
    • spread of paralysis to nearby muscles*
    • trouble swallowing and breathing
    • serious infection
  • Can occur with both Aimovig and Botox:
    • serious allergic reactions

* Botox has a boxed warning from the FDA for spread of paralysis to nearby muscles following injection. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

The only condition that both Aimovig and Botox are used to prevent is chronic migraine headaches.

Treatment guidelines recommend Aimovig as an option for people who can’t reduce their number of migraine days enough with alternative drugs. It’s also recommended for people who can’t take other medications because of side effects or drug interactions.

Botox is recommended by the American Academy of Neurology as an option for treatment in people with chronic migraine.

The effectiveness of these drugs hasn’t been directly compared in clinical studies. However, in separate studies, Aimovig and Botox both achieved effective results in preventing chronic migraine headaches.

  • In a clinical study of Aimovig, about 40 percent of people with chronic migraine who received either 70 mg or 140 mg had half as many migraine days or fewer after three months.
  • In clinical studies of people with chronic migraine, Botox reduced the number of headache days by up to 9.2 days on average per month, over 24 weeks. In another study, around 47 percent of people decreased their number of headache days by at least half.

Costs

Aimovig and Botox are both brand-name medications. There are currently no generic forms available of either drug.

According to estimates from GoodRx.com, Botox is typically less expensive than Aimovig. The actual price you would pay for either drug would depend on your dose, insurance plan, your location, and the pharmacy you use.

Aimovig vs. Emgality

Aimovig contains a monoclonal antibody called erenumab. Emgality contains a monoclonal antibody called galcanezumab. A monoclonal antibody is a type of drug developed in a lab. These drugs are made from immune system cells. They work by blocking the activity of specific proteins in your body.

Aimovig and Emgality both block the activity of a protein in your body called calcitonin gene-related peptide (CGRP). CGRP causes inflammation and vasodilation (widening of blood vessels) in the brain, which can result in migraine headaches. By blocking the activity of CGRP, these drugs help stop inflammation and vasodilation. This helps to prevent migraine headaches.

Uses

Aimovig and Emgality are both FDA-approved to prevent migraine headaches in adults.

Forms and administration

Aimovig is supplied in a single-dose prefilled autoinjector. Emgality is supplied in a single-dose prefilled syringe and a single-dose prefilled pen. Both drugs are given as a subcutaneous injection (an injection under the skin). You can give the injections to yourself at home once a month.

Both drugs can be injected under the skin at certain places on your body. These are:

  • your belly
  • the front of your thighs
  • the back of your upper arms

Emgality can also be injected under the skin of your buttocks.

Aimovig is prescribed as a 70-mg or 140-mg monthly injection. Emgality is prescribed as a 120-mg monthly injection.

Side effects and risks

Aimovig and Emgality are similar drugs that cause some of the same common and serious side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of serious side effects that can occur with Aimovig, with Emgality, or with both drugs (when taken individually).

  • Can occur with Aimovig:
    • constipation
    • muscle cramps
    • muscles spasms
    • flu-like symptoms
  • Can occur with Emgality:
  • Can occur with both Aimovig and Emgality:
    • injection site reactions
    • back pain
    • upper respiratory tract infection (such as the common cold or a sinus infection)

Serious side effects

Severe allergic reaction is a rare serious side effect for both Aimovig and Emgality. (For more information, see “Allergic reaction” under “Aimovig side effects” above).

Immune reaction

In clinical trials for each drug, a small number of people had an immune reaction to Aimovig and Emgality. With this kind of reaction, the body’s immune system developed antibodies against the drugs.

Antibodies are proteins in your immune system that fight off foreign substances in your body. Your body can make antibodies to any foreign substance, including monoclonal antibodies such as Aimovig and Emgality.

If your body develops antibodies to one of these drugs, it’s possible that the drug will no longer work to prevent migraine headaches for you.

In clinical studies of Aimovig, more than 6 percent of people taking the drug developed antibodies to it. And in clinical studies of Emgality, almost 5 percent of people developed antibodies to Emgality.

Because Aimovig and Emgality were approved in 2018, it’s too early to know how many people might have this kind of reaction. It’s also too early to know how it could affect how people use these drugs in the future.

Effectiveness

Aimovig and Emgality haven’t been compared in clinical studies, but both are effective for preventing migraine headaches.

Treatment guidelines recommend Aimovig and Emgality as options for people with episodic or chronic migraine who:

  • can’t take other medications because of side effects or drug interactions
  • can’t reduce their number of monthly migraine days enough with other medications

Episodic migraine

Separate studies of Aimovig and Emgality showed that both medications are effective for preventing episodic migraine headaches:

  • In clinical studies of Aimovig, up to 50 percent of people with episodic migraine who received 140 mg of the drug reduced their migraine days by at least half over six months. About 40 percent of people who received 70 mg saw similar results.
  • In Emgality’s clinical studies of people with episodic migraine, around 60 percent of people reduced their number of migraine days by at least half over six months of Emgality treatment. Up to 16 percent were migraine-free after six months of treatment.

Chronic migraine

Separate studies of Aimovig and Emgality showed that both medications are effective for preventing chronic migraine headaches:

  • In a three-month clinical study of people with chronic migraine, about 40 percent of people who took either 70 mg or 140 mg of Aimovig had half as many migraine days or fewer with treatment.
  • In a three-month clinical study of people with chronic migraine, almost 30 percent of people who took Emgality for three months had half as many migraine days or fewer with treatment.

Costs

Aimovig and Emgality are both brand-name medications. There are currently no generic forms available of either drug. Brand-name drugs usually cost more than generics.

According to estimates from GoodRx.com, Aimovig and Emgality cost nearly the same amount. The actual price you would pay for either drug would depend on your dose, insurance plan, your location, and the pharmacy you use.

Aimovig vs. Topamax

Aimovig contains a monoclonal antibody called erenumab. A monoclonal antibody is a type of drug developed from immune system cells. Drugs of this type are made in a lab. Aimovig helps to prevent migraine headaches by stopping the activity of specific proteins that cause them.

Topamax contains topiramate, a type of drug that’s also used to treat seizures. It’s not well understood how Topamax works to prevent migraine headaches. It’s thought that the drug decreases overactive nerve cells in the brain that might cause migraine headaches.

Uses

Both Aimovig and Topamax are FDA-approved to prevent migraine headaches. Aimovig is approved for use in adults, while Topamax is approved for use in adults and children aged 12 and older.

Topamax is also approved to treat epilepsy.

Forms and administration

Aimovig comes in a single-dose prefilled autoinjector. It’s given as an injection under your skin (subcutaneous) that you give yourself at home once per month. The typical dose is 70 mg, but some people may benefit from a 140-mg dose.

Topamax comes as an oral capsule or oral tablet. The usual dosage is 50 mg taken twice daily. Depending on your doctor’s recommendation, you may start on a lower dosage and increase it to the usual dosage over a couple of months.

Side effects and risks

Aimovig and Topamax work in different ways in the body and therefore have different side effects. Some of the common and serious side effects of both drugs are below. The list below does not include all possible side effects.

More common side effects

These lists contain examples of serious side effects that can occur with Aimovig, with Topamax, or with both drugs (when taken individually).

  • Can occur with Aimovig:
    • injection site reactions
    • back pain
    • constipation
    • muscle cramps
    • muscle spasms
    • flu-like symptoms
  • Can occur with Topamax:
    • sore throat
    • fatigue
    • paresthesia (feeling of “pins and needles”)
    • nausea
    • diarrhea
    • weight loss
    • loss of appetite
    • trouble concentrating
  • Can occur with both Aimovig and Topamax:
    • respiratory tract infection (such as the common cold or a sinus infection)

Serious side effects

These lists contain examples of serious side effects that can occur with Aimovig, with Topamax, or with both drugs (when taken individually).

  • Can occur with Aimovig:
    • few unique serious side effects
  • Can occur with Topamax:
    • vision problems, including glaucoma
    • decreased sweating (inability to regulate body temperature)
    • metabolic acidosis
    • suicidal thoughts and actions
    • thought problems such as confusion and memory issues
    • depression
    • encephalopathy (brain disease)
    • kidney stones
    • increased seizures when drug is stopped suddenly (when drug is used for seizure treatment)
  • Can occur with both Aimovig and Topamax:
    • serious allergic reactions

Effectiveness

The only purpose both Aimovig and Topamax are FDA-approved for is migraine prevention.

Treatment guidelines recommend Aimovig as an option for preventing episodic or chronic migraine headaches in people who:

  • can’t take other medications because of side effects or drug interactions
  • can’t reduce their number of monthly migraine headaches enough with other medications

Treatment guidelines recommend Topiramate as an option for preventing episodic migraine headaches.

Clinical studies have not directly compared the effectiveness of these two drugs in preventing migraine headaches. But the drugs have been studied separately.

Episodic migraine

Separate studies of Aimovig and Topamax showed that both drugs were effective in preventing episodic migraine headaches:

  • In Aimovig clinical studies, up to 50 percent of people with episodic migraine who received 140 mg cut their migraine days by at least half over six months of treatment. About 40 percent of people who received 70 mg saw similar results.
  • In clinical studies of people with episodic migraine who took Topamax, those aged 12 years and older had about two fewer migraine headaches each month. Children aged 12 through 17 with episodic migraine had three fewer migraine headaches each month.

Chronic migraine

Separate studies of the drugs showed that both Aimovig and Topamax were effective in preventing chronic migraine headaches:

  • In a three-month clinical study of Aimovig, about 40 percent of people with chronic migraine headaches who received either 70 mg or 140 mg had half as many migraine days or fewer after treatment.
  • In a study that looked at the results of several clinical trials found that in people with chronic migraine, Topamax reduced the number of migraine headaches or headaches by about five to nine each month.

Costs

Aimovig and Topamax are both brand-name medications. Brand-name medications usually cost more than generic medications. Aimovig is not available in a generic form, but Topamax comes as a generic called topiramate.

According to estimates from GoodRx.com, Topamax may cost more or less than Aimovig, depending on your dose. And topiramate, the generic form of Topamax, will cost less than either Topamax or Aimovig.

The actual price you would pay for any of these drugs would depend on your dose, your insurance plan, your location, and the pharmacy you use.

Aimovig and alcohol

There is no interaction between Aimovig and alcohol.

Still, some people may feel the drug is less effective if they drink alcohol while taking Aimovig. This is because alcohol can be a migraine trigger for many people. Even small amounts of alcohol can cause a migraine for them.

You should avoid drinks that contain alcohol if you find that alcohol causes more painful or more frequent migraine headaches.


Aimovig interactions

Many drugs can interact with other medications. Different effects can be caused by different interactions. For example, some interactions can interfere with how well a drug works, while others can cause more side effects.

Aimovig doesn’t generally have drug interactions. This is because of the way Aimovig is processed in your body.

How Aimovig is metabolized

Many drugs, herbs, and supplements are metabolized (processed) by enzymes in your liver. But monoclonal antibody drugs, such as Aimovig, are not usually processed in the liver. Instead, this kind of drug is processed inside other cells in your body.

Because Aimovig isn’t processed in the liver like many other drugs are, it generally doesn’t interact with other drugs.

If you have any concerns about combining Aimovig with other medications you may be taking, talk with your doctor. And be sure to tell them about all prescription, over-the-counter, and other medications you take. You should also tell them about any herbs, vitamins, and nutritional supplements you use.

Instructions on how to take Aimovig

Aimovig comes as an injection that’s given under your skin (subcutaneous). You give yourself the injection at home once per month. The first time you get a prescription for Aimovig, your healthcare provider will explain how to give yourself the injection.

Aimovig comes in a single-dose (70 mg) autoinjector. Each autoinjector contains only one dose and is meant to be used once and then thrown away. (If your doctor prescribes 140 mg per month, you’ll use two autoinjectors each month.)

Below is information on how to use the prefilled syringe. For other details, video, and images of injection instructions, see the manufacturer’s website.

How to inject

Your doctor will prescribe either 70 mg once per month or 140 mg once per month. If you’re prescribed 70 mg monthly, you’ll give yourself one injection. If you’re prescribed 140 mg monthly, you’ll give yourself two separate injections, one after the other.

Preparing to inject

  • Take your Aimovig autoinjector from the refrigerator 30 minutes before you plan to do your injection. This will allow the drug to warm up to room temperature. Leave the cap on the autoinjector device until you’re ready to inject the drug.
  • Do not try to warm up the autoinjector faster by microwaving it or running hot water over it. Also, do not shake the autoinjector. Doing these things can make Aimovig less safe and effective.
  • If you accidentally drop the autoinjector, do not use it. Small components of the autoinjector may be broken inside, even if you cannot see any damage.
  • While you’re waiting for Aimovig to come to room temperature, find other supplies you will need. These include:
    • an alcohol wipe
    • cotton balls or gauze
    • adhesive bandages
    • disposal container for sharps
  • Check the autoinjector and make sure the medication does not look cloudy. It should be colorless to very pale yellow in color. If it looks discolored, cloudy, or has any solid pieces in the liquid, do not use it. If needed, contact your doctor about getting a new one. Also, check the expiration date on the device to make sure the drug is not expired.
  • After washing your hands with soap and water, choose an injection site. Aimovig can be injected at these places:
    • your belly (at least 2 inches away from your belly button)
    • the front of your thighs (at least 2 inches above your knee or 2 inches below your groin)
    • the back of your upper arms (if someone else is giving you the injection)
  • Use an alcohol wipe to clean the area you plan to inject. Let the alcohol dry completely before you inject the medication.
  • Do not inject Aimovig into an area of skin that’s bruised, hard, red, or tender.

Using the autoinjector

  1. Pull the white cap straight off the autoinjector. Do this no more than five minutes before you will use the device.
  2. Stretch or pinch the area of skin where you plan to inject the drug. Create a firm area of skin about 2 inches wide for your injection.
  3. Place the autoinjector on your skin at a 90-degree angle. Firmly press down onto your skin as far as it will go.
  4. Press the purple start button at the top of the autoinjector until you hear a click.
  5. Release the purple start button but continue holding the autoinjector down onto your skin until the window on the autoinjector turns yellow. You may also hear or feel a “click.” This could take up to 15 seconds. It’s important to do this step to make sure you get the entire dose.
  6. Remove the autoinjector from your skin and dispose of it in your sharps disposal container.
  7. If there is any blood at the injection site, press a cotton ball or gauze onto the skin, but do not rub. Use an adhesive bandage if needed.
  8. If your dose is 140 mg per month, repeat these steps with the second autoinjector. Do not use the same injection site as the first injection.

Timing

Aimovig should be taken once per month. It can be taken at any time of the day.

If you miss a dose, take Aimovig as soon as you remember. The next dose should be one month after you take that one. Using a medication reminder tool can help you remember to take Aimovig on schedule.

Taking Aimovig with food

Aimovig can be taken with or without food.

Storage

Aimovig should be stored in the refrigerator. It can be taken out of the refrigerator but must be used within seven days. Do not put it back in the refrigerator once it has been taken out and brought to room temperature.

Don’t freeze Aimovig. Also, keep it in its original package to protect it from light.


How Aimovig works

Aimovig is a drug called a monoclonal antibody. This kind of drug is made in a lab from immune system proteins. Aimovig works by stopping the activity of a protein in your body called calcitonin gene-related peptide (CGRP). CGRP can cause inflammation and vasodilation (widening of blood vessels) in your brain.

The inflammation and vasodilation brought on by CGRP is a possible cause of migraine headaches. In fact, when a migraine headache is starting to occur, people have higher levels of CGRP in their bloodstream. Aimovig helps prevent a migraine by stopping the activity of CGRP.

While most medications work by affecting many substances in your body, monoclonal antibodies such as Aimovig work on only one protein in the body. Because of this, Aimovig may cause fewer drug interactions and side effects. This can make it a good treatment option for people who can’t take other medications due to side effects or interactions.

Aimovig may also be a good treatment option for people who haven’t found another medication that can reduce their migraine days enough.

How long does it take to work?

After you start taking Aimovig, it may take a few weeks to see an improvement in your migraine headaches. Aimovig may take full effect after several months.

Many people who took Aimovig during clinical trials had fewer migraine days within one month of starting the drug. People also had fewer migraine days after continuing the treatment over several months.

Aimovig and pregnancy

There haven’t been enough studies done to know if Aimovig is safe to take during pregnancy. Animal studies did not show any risk to the pregnancy when Aimovig was given to a pregnant female. However, animal studies don’t always predict whether drugs will be safe in humans.

If you’re pregnant or considering becoming pregnant, talk with your doctor to see if Aimovig is right for you. You may need to wait until you’re no longer pregnant to use Aimovig.

Aimovig and breastfeeding

It’s not known if Aimovig passes into breast milk. Therefore, it’s not clear if Aimovig is safe to use while breastfeeding.

If you’re considering treatment with Aimovig while you’re breastfeeding your child, talk with your doctor about the benefits and risks. You may need to stop breastfeeding if you begin taking Aimovig.


Common questions about Aimovig

Here are answers to some frequently asked questions about Aimovig.

Does stopping Aimovig cause withdrawal?

There have been no reports of withdrawal effects after stopping Aimovig. However, Aimovig was only recently approved by the FDA, in 2018. The number of people who have used and stopped Aimovig therapy is still limited.

Is Aimovig a biologic?

Yes. Aimovig is a monoclonal antibody, which is a type of biologic. A biologic is a drug that’s developed from biological material, rather than chemicals.

Because they interact with very specific immune system cells and proteins, biologics such as Aimovig are thought to have fewer side effects compared to drugs that affect a wider range of body systems, as other migraine drugs do.

Can you use Aimovig to treat a migraine?

No. Aimovig is only used to prevent a migraine headache before it starts. It will not work to treat a migraine that has already started.

Does Aimovig cure migraine?

No, Aimovig will not cure migraine. No medications are currently available to cure migraine.

How is Aimovig different from other migraine drugs?

Aimovig is different from most other migraine drugs because it was the first FDA-approved medication specifically made to prevent migraine headaches. Aimovig is part of a new class of drugs called calcitonin gene-related peptide (CGRP) antagonists.

Most other drugs used to prevent migraine headaches were actually developed for other reasons, such as treating seizures, high blood pressure, or depression. Many of these drugs are used off-label to prevent migraine headaches.

Being a monthly injection also makes Aimovig different from most other migraine prevention drugs. Most of these other drugs come as tablets or pills. Botox is an alternative drug that comes as an injection. However, it has to be given in a doctor’s office once every three months. You can give yourself injections of Aimovig at home.

And unlike most other migraine prevention drugs, Aimovig is a monoclonal antibody. This is a type of medication developed in a lab. It’s made from immune system cells.

Monoclonal antibodies are broken down inside many different cells in the body. Other migraine prevention drugs are broken down by the liver. Because of this difference, monoclonal antibodies such as Aimovig tend to have fewer drug interactions than other medications used to prevent migraine headaches.

If I take Aimovig, can I stop taking my other preventive medications?

Possibly. Each person’s body will respond to Aimovig differently. If Aimovig reduces the number of migraine headaches you have, you may be able to stop taking other preventive medications. But when you first start treatment, your doctor will probably recommend that you start taking Aimovig along with other preventive medications.

After you’ve taken Aimovig for two to three months, your doctor will talk with you about how well the medication is working for you. You and your doctor can discuss stopping the other preventive medications you take or reducing your dosage of these drugs.


Aimovig overdose

Injecting multiple doses of Aimovig can increase your risk of injection site reactions. If you are allergic or hypersensitive to Aimovig or to latex (an ingredient in Aimovig’s packaging), you may be at risk for a more serious reaction.

Overdose symptoms

Symptoms of an overdose can include:

  • severe pain, itchiness, or redness in area near injection
  • flushing
  • hives
  • angioedema (swelling under the skin)
  • swelling of the tongue, throat, or mouth
  • trouble breathing

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

Aimovig warnings

Before taking Aimovig, talk with your doctor about your health history. Aimovig may not be right for you if you have certain medical conditions. These include:

  • Latex allergy. The Aimovig autoinjector contains a form of rubber that is similar to latex. This may cause an allergic reaction in people who are allergic to latex. If you have a history of severe reactions to products that contain latex, Aimovig may not be the right medication for you.

Aimovig expiration and storage

When Aimovig is dispensed from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically one year from the date the medication was dispensed.

The purpose of such expiration dates is to guarantee the effectiveness of the medication during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications.

How long a medication remains good can depend on many factors, including how and where the medication is stored.

Aimovig prefilled autoinjector should be stored in the refrigerator. It can be kept outside of the refrigerator for up to seven days. Do not place back in the refrigerator once it has reached room temperature.

Don’t shake or freeze the Aimovig autoinjector. And keep the autoinjector in the original packaging to protect it from light.

If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Professional information for Aimovig

The following information is provided for clinicians and other healthcare professionals.

Mechanism of action

Aimovig (erenumab) is a human monoclonal antibody that binds to the calcitonin gene-related peptide (CGRP) receptor and prevents the CGRP ligand from activating the receptor.

Pharmacokinetics and metabolism

Aimovig is administered monthly and reaches steady-state concentrations after three doses. Maximum concentration is reached in six days. Metabolism does not occur via cytochrome P450 pathways.

Binding to the CGRP is saturable and drives elimination at low concentrations. At higher concentrations, Aimovig is eliminated through nonspecific proteolytic pathways. Renal or hepatic impairment are not expected to affect pharmacokinetic properties.

Contraindications

There are no contraindications to Aimovig use.

Storage

Aimovig prefilled autoinjector should be stored in the refrigerator at a temperature between 36⁰F and 46⁰F (2⁰C and 8⁰C). It may be removed from the refrigerator and stored at room temperature (up to 77⁰F, or 25⁰C) for 7 days.

Keep Aimovig in the original packaging to protect it from light. Don’t place it back in the refrigerator once it has come to room temperature. Do not freeze or shake the Aimovig autoinjector.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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